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Prenatal Visits

  1. #1
    Default Prenatal Visits
    Medical Coding Books
    Is anyone else using a Prenatal Flow record for the documentation of prenatal visits? Or an ACOG approved prenatal Record?

    If so, when a patient presents for a routine prenatal follow-up visit with no problems, or concerns (just a plain prenatal visit) are you getting a 99212 or 99213. Now I realize it depends on what the provider documentes, lets say they only document :
    FHR, fundal height, wks gestation, fetal movement, weight this visit, BP, edema, pain/pressure, and states no complaints. I would say a 99212.

    Please feel free to give any and all responses, I am looking for all kinds of input.

    Thank you.

  2. Default
    should you use 0502F (prenatal visit) instead of 99212?
    use 0501F for initial ob visit
    use 0502F for subsequent ob visits
    use 0503F for post-partum visits

  3. Default ob visits
    with the acog flow sheet i use
    0501F for initial ob visit (more time)
    0502F for follow up prenatal visits
    0503F for post-partum visit

  4. #4
    Thanks, I will check in to these codes.

  5. #5
    After further research those codes listed above are used for PQRI in addition to an E/M code....??? Or am I missing something?

    Thanks Jeanne

  6. #6
    Default Additional help needed
    I am curious about which codes to use to and I am afraid you lost me on the PRQI abberviation above??

    Our doctor is a Family/Primary phyiscian and performed a prenatal care visit. She will not be delivering the baby. From the Maternity care section in the CPT it states:
    " For 1-3 antepartum care visits see appropriate E/M codes). 59425 is Antepartum care only 4-6 visits and 59426 is 7 or more visits."

    I also read the category II codes "0500f Initial prenatal care, 0501F Prenatal flow sheet documented in medical record, and 0502F Subsequent prenatal visits"

    Isn't the category II codes mainly for preformance measures and not really billing? I thought these were optional codes?

    I guess I am confused on which ones we are suppose to use if the Dr's speciality is not necessarily OBGYN but more Primary Care.


  7. #7
    You should be choosing a code based on the guidelines you quoted. If your doctor saw the patient this one time only, bill out the appropriate E&M code. If your doctor is going to see the patient again, wait until patient's care in your practice is done, and then choose the appropriate code. That way if the patient has more than 3 visits, you aren't double billing anything. Be prepared to appeal a denial--most carriers will initially deny your claim stating "included in global service" because they are expecting to see the global code that includes delivery. You'll have to explain that patient was in your care for X amount of time onlym and your doctor will NOT be doing the delivery.

    As to level of E&M, my OB docs choose their own level if we have to separate out billing for some reason. They do use the standard ACOG prenatal flow sheets. They usually bill out a 99213.

    Does that help?

    Becky, CPC

  8. Unhappy PQRI Prenatal Category II Codes
    Hello -

    I'm trying to no avail thus far, to find documentation that states it's ok or not,
    for providers to submit claims only with cat II codes. Submit the Category II code
    without an actual CPT 99213 etc code......for prenatal visits.
    Supposedly there exists a cross-walk between Category I and II, haven't found that

  9. Default
    I too am having problems with a 99212 or a 99213 on my medicaid patients. any assistance would be appreciated on how others audit their ob charges

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